Medicare Case Review

Update on Medicare Case Review

The Centers for Medicare & Medicaid Services (CMS) has made significant changes to its national Quality Improvement Organization (QIO) program. Under the new program structure, QIOs are not permitted to serve both the case review and quality improvement roles. The TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) has the health care quality improvement role and therefore is not participating in case review, referred to as Beneficiary and Family Centered Care (BFCC).

Health care providers and Medicare beneficiaries in Texas, Arkansas, Missouri and Oklahoma must contact the BFCC QIO KEPRO toll-free at 1-844-430-9504, and health care providers and Medicare beneficiaries in Puerto Rico must contact the BFCC QIO Livanta toll-free at 1-866-815-5440 for all appeal requests and quality of care concerns.